Monday, June 12, 2006

Insurance Woes

I haven't even gotten to the specialist bills yet and already I'm having insurance woes. Actually, I strongly suspect that the specialists office has more practice in dealing with thorny insurance issues and will probably likely succeed in actually getting them to pay something.

Anyway, my insurance company denied the $1100+ bills for the HSG, even though my Summary of Benefits clearly states that Infertility Diagnostic Treatment is covered. The first call to my insurance company didn't get me anywhere. The very unhelpful rep suggested I call the OB. 12 days ago I left the first of half a dozen messages for the OB's billing department and am still waiting for a return call. Today I happened to notice that the insurance statements contain the billing codes, so I looked them up. Sure enough, they both related to an HSG. So I got back on the phone with the insurance company, determined to get somewhere. After a very long wait and a return phone call, the answer is that the codes my OB's office used indicate that the HSG was an infertility treatment rather than a diagnostic test, hence the denial.

So I'm back to the OB's office. I just wrote them a letter detailing the problem and exactly what they need to do. I was very nice and professional. I'll save the scathing "no one ever returned my phone call" for after they fix the problem. If I haven't heard from them by Friday, I'm gathering up all my paperwork and showing up at their office. This is ridiculous!


Lorem ipsum said...

They really need to get the code and refile that. Good luck on that. (Oh, how they LOVE to throw around the 'i' word, don't they?)

Josefina said...

I can't believe negligence goes all the way to US!!! I thought I was the only one leaving in a "I don't care about my client" country...LOL...I hope they can fix it ASAP!!!